Z-Lengthening of the Iliotibial Band to Treat Recalcitrant Cases of Trochanteric Bursitis

Abstract

Greater trochanteric bursitis is a relatively common presentation at hip clinics. It presents with pain around the greater trochanter. Diagnosis is usually made on clinical grounds when other hip and spinal pathologies are ruled out and there is tenderness present over the trochanteric region. Rheumatoid arthritis (1), athletic injury (2), total hip arthroplasty (3) and idiopathic disease (4) are some of the known causes of trochanteric bursitis. Treatment is mainly non-operative and expectant; however various operative interventions have been described in the literature. We present a series of 16 patients who had recalcitrant trochanteric bursitis following failed non-operative treatment and were treated with bursectomy and Z-lengthening of the iliotibial band. All 14 patients who answered the questionnaire were happy with the outcome of operation and 13/14 patients would undergo a similar procedure again. To the best of our knowledge, this is the only series in the literature describing this particular procedure for treatment of trochanteric bursitis.

Gluteal Tendon Repair Augmented with a Synthetic Ligament: Surgical Technique and a Case Series

“…Ultrasound targeted corticosteroid injections may provide some immediate benefit (8), though a high symptom recurrence rate at one year has been demonstrated for all conservative treatment modalities in primary care (3). Surgical treatment options for severe or resistant GTPS conventionally involve decompression or lengthening of the fascia lata by trans-section or fenestration in combination with resection of the sub-gluteus maximus bursa (9-11). However, observation of tears at the insertion of gluteus medius and minimus suggests that tendon degeneration may in fact be the primary pathology driving the overlying bursitis and fascial irritation in GTPS, analogous to degenerative rotator cuff in the shoulder (6, 12).…”

The management of greater trochanteric pain syndrome: A systematic literature review

“…12,13,27 The techniques of ITB lengthening varied between the studies, and all were proximal ITB techniques except one, which was distal. 13 Z-lengthening was undertaken in two studies 27,65 ; cross-incision was used in one study 23 and longitudinal release in one study. 68 Trochanteric bursectomy was performed in all the proximal procedures.…”

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

“…d Endoscopic or open bursectomy with or without iliotibial band (ITB) release showed promising results in the treatment of recalcitrant trochanteric bursitis. 4 , 12 , 15 , 46 Blakey et al 4 analyzed the effect of radiofrequency microdebridement as an adjunct to arthroscopic gluteal bursectomy and ITB release for grades 1 to 3 tendinopathy. Even though the treatment led to significant improvements in patients with recalcitrant gluteal tendinopathy, the addition of radiofrequency microdebridement showed no statistically significant additional benefit to arthroscopic bursectomy and ITB release in this small randomized controlled trial.…”

“…Longitudinal or cross-shape splitting of the ITB did not have inferior outcomes when compared to Z-lengthening procedures at the level of the greater trochanter or at the supracondylar level. 12,15,46 The adjunct of radiofrequency microdebridement to arthroscopic bursectomy and ITB release did not enhance patient-reported outcomes (LoE 1b). 4 Complication rates up to 8% have been reported for these soft tissue procedures, 50 while a series of trochanteric reduction osteotomy was found to have a 30% complication rate at 2-year follow-up.…”